静脉输注利多卡因在海洛因依赖者上消化道异物取出术中的应用
|
摘要
目的观察静脉输注利多卡因在海洛因依赖者经胃镜行上消化道异物取出术中的应用效果.方法选择门诊40例经胃镜行上消化道异物取出术的男性海洛因依赖者,美国麻醉医师协会(ASA)Ⅰ~Ⅱ级,采用随机数字表法随机分为2组,利多卡因组(L组)和对照组(C组)每组20例,L组诱导前2 min静脉给予利多卡因1.5mg/kg,持续输注1.5 mg/(kg·h)至手术结束,C组注射等剂量的生理盐水.麻醉诱导后经胃镜行上消化道异物取出术,记录麻醉诱导前(T0)、麻醉诱导后(T_1)、胃镜通过咽腔进入食道时(T_2)、钳夹异物出食道进咽腔时(T_3)、患者清醒时(T4)各时间点心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、氧饱和度(pulse oxygen saturation,SpO_2)的值.观察术中体动,呛咳及戒断症状的情况.记录诱导时间,苏醒时间及丙泊酚用量.结果 2组操作均顺利完成,L组与C组相比,麻醉诱导后各时间点血流动力学变化明显低于C组,且有统计学差异(P<0.05).L组SpO_2在各时间点均无明显改变,C组SpO_2在诱导后T_2、T_3时较T0下降(P<0.05).术中体动、呛咳及术后戒断症状的发生率L组[(30%)、(75%)、(0.0%)]明显低于C组[(75%)、(80%)、(25%)](P<0.05).L组丙泊酚用量[(3.8±0.3)mg/kg]及诱导时间[(115.2±10.1)s]均低于C组[(5.6±0.3) mg/kg]和[(146.5±13.2) s](P <0.05).苏醒时间无明显差异[(3.4±0.6)、(3.2±0.5) min](P>0.05).结论静脉输注利多卡因能有效抑制胃镜上消化道异物取出术中海洛因依赖者的应激性,减少术中丙泊酚用量,提高麻醉效应.
Objective To observe the effect of intravenous infusion of lidocaine in the removal of upper gastrointestinal foreign body of heroin addicts. Methods 40 Heroine addicts were divided into two groups randomly using the random number table method. All of them were adult males and the ASA level was Ⅰ-Ⅱ. All of them were undergone the endoscopic treatment of foreign body in upper gastrointestinal tract. Those in the lidocaine group(group L) were given 1.5 mg/kg of lidocaine 2 min before induction, and continued infusion of1.5 mg/(kg.h) until the end of operation.Those in the control group(group C) were given the saline as the placebo. Heart rate(HR),mean artery pressure(MAP) and Surplus pulse O_2(SpO_2) at different time points( before induction(T0), after induction(T_1), the gastroscopy through the pharyngeal cavity(T_2), extract of the foreign body through the pharyn geal cavity(T_3) and patient's awaking time(T4) were recorded. The body movement,irritating cough and withdrawal symptom during the treatmentwere were observed and the induction time, the awaking time and the dose of propofol in both groups were recorded. Results The hemodynamic change in group L was less than that in group C after the anesthesia induction at different time points(P < 0.05). SpO_2 of group L at different time points had no obvious difference.SpO_2 of group C at T_2、T_3 was decreased compared with T0. Patients in group L suffered less body movement、irritating cough and withdrawal symptom [(30%),(75%),(0.0%)] than those in group C [(75%),(80%),(25%)](P < 0.05). The dose of propofol was less in group L than that in group C[(3.8±0.3),(5.6±0.3) mg/kg mg/kg](P < 0.05). The time of recovery had no obvious difference between the two groups [(3.4 ±0.6),(3.2 ±0.5)min](P > 0.05). Conclusion Intravenous infusion of lidocaine can effectively suppress the stress of the removal of the foreign bodies of the gastroenteroscopy, and reduce the dosage of propofol in the operation and improve the effect of anesthesia.
Objective To observe the effect of intravenous infusion of lidocaine in the removal of upper gastrointestinal foreign body of heroin addicts. Methods 40 Heroine addicts were divided into two groups randomly using the random number table method. All of them were adult males and the ASA level was Ⅰ-Ⅱ. All of them were undergone the endoscopic treatment of foreign body in upper gastrointestinal tract. Those in the lidocaine group(group L) were given 1.5 mg/kg of lidocaine 2 min before induction, and continued infusion of1.5 mg/(kg.h) until the end of operation.Those in the control group(group C) were given the saline as the placebo. Heart rate(HR),mean artery pressure(MAP) and Surplus pulse O_2(SpO_2) at different time points( before induction(T0), after induction(T_1), the gastroscopy through the pharyngeal cavity(T_2), extract of the foreign body through the pharyn geal cavity(T_3) and patient's awaking time(T4) were recorded. The body movement,irritating cough and withdrawal symptom during the treatmentwere were observed and the induction time, the awaking time and the dose of propofol in both groups were recorded. Results The hemodynamic change in group L was less than that in group C after the anesthesia induction at different time points(P < 0.05). SpO_2 of group L at different time points had no obvious difference.SpO_2 of group C at T_2、T_3 was decreased compared with T0. Patients in group L suffered less body movement、irritating cough and withdrawal symptom [(30%),(75%),(0.0%)] than those in group C [(75%),(80%),(25%)](P < 0.05). The dose of propofol was less in group L than that in group C[(3.8±0.3),(5.6±0.3) mg/kg mg/kg](P < 0.05). The time of recovery had no obvious difference between the two groups [(3.4 ±0.6),(3.2 ±0.5)min](P > 0.05). Conclusion Intravenous infusion of lidocaine can effectively suppress the stress of the removal of the foreign bodies of the gastroenteroscopy, and reduce the dosage of propofol in the operation and improve the effect of anesthesia.
引文
[1]钱自亮,吕洪城,朱木棕.吸毒患者的麻醉处理[J].临床麻醉学杂志,2001,17(2):93.
[2] SUZUKI N,HASEGAWA-MORIYAMA M,TAKAHASHI Y,et a1.Lidoeaine Attenuates the development of diabetic qnduced tactile allodynia by inhibiting microglial activation[J].Anesth Analg,2011,113(4):941-946.
[3]邓小明,姚尚龙,于布为,等.现代麻醉学[M].第4版.北京:人民卫生出版社,2014:1884
[4] RAMSAY M A,SAVEYE T M,SIMPSON B R,et al.Controlled sedation with alphaxalone_alphadolone[J].Br Med J,1974,2(5920):656-659.
[5]顾红群,刘玉杰,张志坚,等.特殊人群上消化道异物的无痛胃镜治疗[J].中国内镜杂志,2007,13(2):166-168.
[6]谭华,吕作均.吸毒者胃肠道金属异物取出术的麻醉处理[J].华中医学杂志,2003,27(4):193-194.
[7]克里斯·查佩里特(CHRIS CHAPLEO),陈钢(译).阿片类药物依赖治疗的国际趋势、国际经验和最佳实践[J].中国药物滥用防治杂志,2015,21(1):1-6.
[8] HERNANDEZ M,Birnbach DJ,Van Z A.Anesthetic management of the illicit-substance-using patient[J].Curr Opin Anaesthesiol,2005,18(3):315-324.
[9]柳培雨,田毅.常见吸毒患者的临床麻醉处理[J].医学与哲学,2011,32(8):43-44.
[10] CAVALIERE F,IACOBONE E,GORGOGLIONE M,et al.Anesthesiologic preoperative evaluation of drug addicted patient[J].Minerva Anestesiol,2005,71(6):367-371.
[11]杨聪玲,袁吴行烁袁邱,等.利多卡因联合丙泊酚行无痛胃镜检查的临床体会[J].中国药物滥用防治杂志,2010,17(1):21-22.
[12]孙艳霞,李天佐.静脉输注利多卡因在术后镇痛中的应用[J].国际麻醉学与复苏杂志,2013,34(7):642-645.
[13] HERNG-YU SUCIE,CHANG ALKIS,TOGIAS ROBERT H,et al.The effects of systemic lidocaine on airway tone and pulmonary function in asthmatic subjects[J]. Anesthesia and Analgesia,2007,104(5)1109-1115.
[14]薛瑛,刘进.静脉利多卡因对无痛胃镜检查中异丙酚全身麻醉的影响[J].华西医学,2013,28(6):864-867.
[15] SS,LIN GT,CHEN JC,et al.Pain on injection of propofol[J]. Acta Anaesthesiologica Sinica,1994,32(2)73-76.
[16] YOU J H,CHOI GJ,KANG H,et al.Introperative systematic lidocaine for pre-emptive analgesics in subtotal gastrectomy:a prospective,randomized,doubleblind,placebocontrolled study[J].Can J Surg,2014,57(3):175-182.
[17] HONEMANN C W,HABNENKAMP K,PODRANSKI T,et a1.Local anesthetics inhibit thromboxane A2 signaling in Xenopus oocytes and human k562 cells[J].Anesth Analg,2004,99(3):930-937.
[18]周莹,朱涛,朱昭琼,等.静脉注射利多卡因对丙泊酚麻醉诱导的影响[J].遵义医学院学报,2014,37(1):111-114.
[2] SUZUKI N,HASEGAWA-MORIYAMA M,TAKAHASHI Y,et a1.Lidoeaine Attenuates the development of diabetic qnduced tactile allodynia by inhibiting microglial activation[J].Anesth Analg,2011,113(4):941-946.
[3]邓小明,姚尚龙,于布为,等.现代麻醉学[M].第4版.北京:人民卫生出版社,2014:1884
[4] RAMSAY M A,SAVEYE T M,SIMPSON B R,et al.Controlled sedation with alphaxalone_alphadolone[J].Br Med J,1974,2(5920):656-659.
[5]顾红群,刘玉杰,张志坚,等.特殊人群上消化道异物的无痛胃镜治疗[J].中国内镜杂志,2007,13(2):166-168.
[6]谭华,吕作均.吸毒者胃肠道金属异物取出术的麻醉处理[J].华中医学杂志,2003,27(4):193-194.
[7]克里斯·查佩里特(CHRIS CHAPLEO),陈钢(译).阿片类药物依赖治疗的国际趋势、国际经验和最佳实践[J].中国药物滥用防治杂志,2015,21(1):1-6.
[8] HERNANDEZ M,Birnbach DJ,Van Z A.Anesthetic management of the illicit-substance-using patient[J].Curr Opin Anaesthesiol,2005,18(3):315-324.
[9]柳培雨,田毅.常见吸毒患者的临床麻醉处理[J].医学与哲学,2011,32(8):43-44.
[10] CAVALIERE F,IACOBONE E,GORGOGLIONE M,et al.Anesthesiologic preoperative evaluation of drug addicted patient[J].Minerva Anestesiol,2005,71(6):367-371.
[11]杨聪玲,袁吴行烁袁邱,等.利多卡因联合丙泊酚行无痛胃镜检查的临床体会[J].中国药物滥用防治杂志,2010,17(1):21-22.
[12]孙艳霞,李天佐.静脉输注利多卡因在术后镇痛中的应用[J].国际麻醉学与复苏杂志,2013,34(7):642-645.
[13] HERNG-YU SUCIE,CHANG ALKIS,TOGIAS ROBERT H,et al.The effects of systemic lidocaine on airway tone and pulmonary function in asthmatic subjects[J]. Anesthesia and Analgesia,2007,104(5)1109-1115.
[14]薛瑛,刘进.静脉利多卡因对无痛胃镜检查中异丙酚全身麻醉的影响[J].华西医学,2013,28(6):864-867.
[15] SS,LIN GT,CHEN JC,et al.Pain on injection of propofol[J]. Acta Anaesthesiologica Sinica,1994,32(2)73-76.
[16] YOU J H,CHOI GJ,KANG H,et al.Introperative systematic lidocaine for pre-emptive analgesics in subtotal gastrectomy:a prospective,randomized,doubleblind,placebocontrolled study[J].Can J Surg,2014,57(3):175-182.
[17] HONEMANN C W,HABNENKAMP K,PODRANSKI T,et a1.Local anesthetics inhibit thromboxane A2 signaling in Xenopus oocytes and human k562 cells[J].Anesth Analg,2004,99(3):930-937.
[18]周莹,朱涛,朱昭琼,等.静脉注射利多卡因对丙泊酚麻醉诱导的影响[J].遵义医学院学报,2014,37(1):111-114.